Consultation and procedure fees on their own accounts

How consultation, procedure and missed-appointment fees from the Healthcare pack reach the practice's ledger on separate income accounts, priced by you.

By Achekam · 11 October 2026 · 4 min read · For Healthcare businesses in South Africa, Nigeria, Kenya

Launching soon. The Industry CRM add-on described in this article is launching soon. This article describes it as it will work at launch.

Ask a practice owner how much of last quarter's income came from consultations and how much from procedures, and the answer is often a shrug. The management accounts show one line called sales or fees, because every invoice lands in the same income account. The split exists only in the practitioner's head, or in a spreadsheet someone builds once a year for the bank.

That split matters. Consultations and procedures have different costs, different time demands and often different growth stories. A practice deciding whether to buy new equipment, add a treatment room or take on another practitioner needs to see them apart. The Healthcare & clinics pack sets this up from the start.

The fee items you start with

When a practice switches the Healthcare pack on, a starter catalogue of fee items is added. It lists:

• consultations;
• missed-appointment fees;
• procedures;
• treatment sessions;
• consumables.

Every item arrives without a price. No starter item in any industry pack carries one: what a consultation costs is for the practice to decide, not for software to suggest. You set each price yourself.

Two income accounts, not one

Switching the pack on also adds the industry's income accounts to the practice's chart of accounts. For healthcare there are two:

The starter items post to these two accounts. Before your first invoice, open each item and check which account it points to, so you know how, for instance, consumables and missed-appointment fees will be reported. If your accountant wants a different split, agree it now rather than reclassifying a year of invoices later.

One practical warning. If your chart already uses one of those account codes for a different type of account, switching the pack on is refused, and the message names the account in the way. Look at your chart for 4250 and 4260 before you begin, and ask your accountant to move anything that clashes.

From attended visit to invoice

Fees reach the ledger through the visit. The pack's appointment workflow sends the booking confirmation, records attendance, and then either invoices the visit or records that it was paid at the till.

When the visit is invoiced, each invoice line names the product it sells and the income account it belongs to. So an invoice for a consultation with a procedure carries two lines, and the posting splits the income between Consultation fees and Procedure and treatment fees in the same journal. Where a line sells a stocked item, such as a consumable, its cost of sales posts in that same journal too.

Here is a worked example in words. A patient comes in for a consultation, and the practitioner performs a minor procedure using a dressing kit. Reception invoices the visit with three lines: the consultation, the procedure and the kit. When the invoice is issued, the consultation goes to Consultation fees, the procedure to Procedure and treatment fees, and the kit to the account its item points to, with its cost of sales recorded alongside. The practice's monthly figures now show what the visit earned, and from what.

Treatment sessions follow the same path. A patient on a course of physiotherapy or wound care attends a series of visits; each attended session is invoiced or paid at the till as it happens, and each line lands in the account its item points to. Over a few months, the practice can see how much of its income comes from courses of treatment rather than one-off consultations, which is useful when deciding how many treatment slots to keep in the diary.

Missed-appointment fees

The starter catalogue includes a missed-appointment fee, which gives the practice the option of charging for a slot that was booked and not used.

Whether to charge is a policy choice, and a sensitive one. A few points worth deciding up front:

• Tell patients first. A fee nobody was told about damages the relationship more than the empty slot did. Put the policy in your practice terms, which the patient signs at registration.
• Decide the exceptions. Illness, emergencies, a first missed visit: agree what reception may waive and who decides.
• Use attendance records. The fee only makes sense when attendance is recorded consistently, so a patient is never charged for a visit they actually attended.

Price the fee yourself, like every other item, and check which account it posts to.

Prices and VAT are yours to set

Because no item carries a price, the first job after switching on is a short pricing session with whoever sets fees in the practice. While you are at it, look at VAT. The treatment of medical services differs between countries; for example, at the time of writing Nigeria zero-rates medical services and medical and pharmaceutical products. For Nigerian practices, the NRS page on Value Added Tax gives zero-rated and exempt examples and sets out what a VAT invoice must show. Confirm the right treatment for each item with your accountant before it goes on an invoice.

A simple sign-off list:

1. Every starter item you intend to use has a price.
2. Every item points to the account you and your accountant agreed.
3. Every item's VAT treatment has been confirmed.
4. Reception knows which item to use for each common visit.

Reading the result

After a month of invoicing this way, ask for the income statement with the two accounts shown separately. It will tell you more about the practice than a year of single-line sales figures. For how visits reach the invoice stage, see from booking confirmation to attended visit, and for following up the amounts patients still owe, statements and reminders for patient accounts.

General guidance only, not advice on your own circumstances. Tax and payroll rules change: check the current position with the authority or your adviser.